Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Japan.
Department of Neurology, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan.
J Neurointerv Surg. 2019 Oct;11(10):964-969. doi: 10.1136/neurintsurg-2018-014627. Epub 2019 Mar 9.
To compare the efficacy of endovascular therapy (EVT) with that of medical treatment in 'real-world 'patients with M2 occlusion.
This was a post hoc analysis of the Recovery by Endovascular Salvage for Cerebral Ultra-acute Embolism Japan Registry 2. Among 2420 patients in the registry, we evaluated patients with isolated M2 occlusion and those with functional independence before the stroke. Multivariable logistic regression analysis was used to evaluate and compare clinical outcomes between EVT and medical treatment. Additional propensity score-matched (PSM) analyses were performed. We performed subgroup analyses of the primary outcome (modified Rankin Scale score 0-2 at 90 days) using forest plots of treatment effects.
Overall, 372 patients with M2 occlusion (n=184 EVT; n=188, medical treatment) were evaluated. The EVT group had a higher baseline National Institutes of Health Stroke Scale score (median (IQR), 15 [9-19] vs 10 [5-16]) and earlier onset to hospital door time (110 [50-258] vs 150 [60-343] min) than the medical treatment group. After adjustment, EVT was significantly associated with higher odds of primary outcome (adjusted OR=2.09; 95% CI 1.26 to 3.47) and lower odds of mortality at 90 days (adjusted OR= 0.27; 95% CI 0.08 to 0.93). After PSM analyses (184 patients were 1:1 matched with each group), EVT was effective and safe relative to medical treatment. Effects favoring EVT were present in several subgroups of interest.
In patients with M2 occlusion, our registry suggests that EVT is effective and safe.
比较血管内治疗（EVT）与药物治疗在“真实世界”M2 闭塞患者中的疗效。
这是对血管内拯救大脑超急性栓塞日本登记研究 2 中 2420 例患者的事后分析。在登记处中，我们评估了孤立 M2 闭塞且中风前有独立功能的患者。采用多变量逻辑回归分析评估并比较 EVT 和药物治疗的临床结局。此外，还进行了倾向评分匹配（PSM）分析。我们使用治疗效果森林图对主要结局（90 天时改良 Rankin 量表评分 0-2）进行了亚组分析。
总体而言，评估了 372 例 M2 闭塞患者（n=184 例 EVT；n=188 例，药物治疗）。与药物治疗组相比，EVT 组基线国立卫生研究院卒中量表评分较高（中位数（IQR），15[9-19]比 10[5-16]），且到医院门口的时间更早（110[50-258]比 150[60-343]min）。校正后，EVT 与主要结局的更高可能性显著相关（校正比值比=2.09；95%置信区间 1.26 至 3.47），90 天时的死亡率较低（校正比值比=0.27；95%置信区间 0.08 至 0.93）。经 PSM 分析（每组 184 例患者进行 1:1 匹配）后，EVT 与药物治疗相比是有效且安全的。EVT 有利的影响在几个感兴趣的亚组中存在。
在 M2 闭塞患者中，我们的登记处表明 EVT 是有效且安全的。
